SUPPORTING OLDER ADULTS WHO LIVE ALONE: UNDERSTANDING THEIR UNMET NEEDS USING NHATS SURVEY DATA

Abstract Research suggests that older adults living alone in the community are at higher risk for poor health-related outcomes due to lack of cohabitants to support their health needs. Using National Health and Aging Trends Study (NHATS) data, we identified community-residing older adults (≥65 years) with assistance needs for Instrumental Activities of Daily Living (IADLs), Activities of Daily Living (ADLs), or mobility. We used bivariate analyses to compare the unmet needs related to IADL, ADL, and mobility tasks between those living alone and those living with others. Of the 3,458 individuals identified, 28.9% (n=1001) lived alone. Those living alone were more likely to be women, unpartnered, and lacking informal caregivers. There was no difference in perceived overall health scores between the groups. Individuals living alone experienced more mobility and IADL-related unmet needs. In the month prior to survey completion, those living alone were more likely to forgo getting out of bed (p=0.031), grocery shopping (p< 0.001), cooking (p< 0.001), and paying bills (p=0.025) due to lack of available assistance. Our findings suggest that older adults living alone may need higher levels of formal assistance with IADLs to remain living in the community. Given the key role IADLs play in promoting quality of life and a person’s ability to remain independent and engaged in the community, it is important to consider IADLs in addition to ADLs when assessing formal care needs for those living alone. Policy makers should prioritize the specific needs of those living alone when developing national aging strategies.

In 2015, the Dutch government implemented a long-term care (LTC) reform primarily designed to promote older adults (≥65 years old) to age-in-place.Increased proportions of older adults living in the community may have resulted in more and longer acute hospitalizations.We evaluated the reform's association with the monthly rate of acute clinical hospitalization and monthly average hospital length of stay (LOS), using an interrupted time series design of national hospital data (2009 to 2018) that controlled for population growth and seasonality, and calculated adjusted incident rate ratios (IRR).The pre-reform trend of hospitalization rate was increasing (IRR 1.002, 95% CI 1.001-1.002).A positive average reform effect was observed (IRR 1.116, 95% CI 1.070-1.165),accompanied by a negative change in trend (IRR 0.996, 95% CI 0.995-0.998).This resulted in a decreasing trend over the post-reform period (IRR 0.997, 95% CI 0.997-0.999).The pre-reform trend of LOS was decreasing (IRR 0.998, 95% CI 0.997-0.998),and the 2015 reform exhibited a positive change in trend (IRR 1.002, 95% CI 1.002-1.003).This resulted in a stabilization of LOS in the post-reform period (IRR 0.999, 95% CI 0.999-1.00).Our findings suggest that the increase in the rate of acute hospitalization after the reform implementation was temporary, whereas the LOS appeared to be longer than expected.
(IADLs), Activities of Daily Living (ADLs), or mobility.We used bivariate analyses to compare the unmet needs related to IADL, ADL, and mobility tasks between those living alone and those living with others.Of the 3,458 individuals identified, 28.9% (n=1001) lived alone.Those living alone were more likely to be women, unpartnered, and lacking informal caregivers.There was no difference in perceived overall health scores between the groups.Individuals living alone experienced more mobility and IADL-related unmet needs.In the month prior to survey completion, those living alone were more likely to forgo getting out of bed (p=0.031),grocery shopping (p< 0.001), cooking (p< 0.001), and paying bills (p=0.025)due to lack of available assistance.Our findings suggest that older adults living alone may need higher levels of formal assistance with IADLs to remain living in the community.Given the key role IADLs play in promoting quality of life and a person's ability to remain independent and engaged in the community, it is important to consider IADLs in addition to ADLs when assessing formal care needs for those living alone.Policy makers should prioritize the specific needs of those living alone when developing national aging strategies.

THE ASSOCIATIONS OF GRIP STRENGTH WITH CO-RESIDENCE WITH ADULT CHILDREN AND MORTALITY CHINESE OLDER ADULTS
Long Chen 1 , Shiying Gao 1 , Yan Du 2 , and Rumei Yang 1 , 1. Nanjing Medical University School of Nursing, Nanjing, Jiangsu, China (People's Republic), 2. UT Health San Antonio, San Antonio, Texas, United States Aging in place is a key to coping with population aging in China.Grip strength (GS) is one of the key determinants of aging in place.Under such a context, whether living with adult children would affect older adults' GS and mortality is worth exploring.The objective of this study was to assess the associations of GS with adult children co-residence and mortality, and examine whether the association between GS and mortality would be moderated by adult children co-residence status.We used a nationally representative sample of Chinese older adults who completed three-wave (2011, 2013, and 2015 years) of the China Health and Retirement Longitudinal Study (N=1,088, aged 50-100 years).Mortality status was determined by in-person interviews in waves 2 and 3. GS was treated as a continuous variable in mixed-effect models and a binary variable in Cox regression models (poor GS if GS< 18kg for women and GS< 28kg for men).On average, 52.2% (n=535) participants co-resided with adult children.Adult-children co-residence was longitudinally related to better GS over time (β=2.96,95% CI=0.53-3.60,p=0.009).Overall, poor GS was an independent risk factor for mortality (HR=1.33,95% CI=1.04-1.70,p=0.022) after controlling for covariates (e.g., age, sex), but this association was not modified by co-residence status (HR=1.02,95% CI=0.64-1.64,p=0.900).These results suggest that co-residence with adult children might be beneficial to better GS, which might contribute to less mortality.Future studies are needed to explore the underlying mechanisms through which the co-residence affects GS, thus, contributes to mortality.

CLINICAL PRACTICE AND HEALTH
Abstract citation ID: igad104.2253

A MOBILE HOME HEALTH CARE PHYSICIAN FOR OLDER PERSONS WITH EXTENSIVE HEALTH CARE NEEDS
Lina Emmesjö, Jenny Hallgren, Anna Dahl Aslan, and Catharina Gillsjö (Gillsjo), University of Skövde, Skövde, Vastra Gotaland, Sweden Background: The rapidly increasing older population with extensive care needs has shifted health care from institutions to the older person's home.A cross-organisational integrated care model was created by health care authorities to meet these challenges, the Mobile integrated care model.The Mobile integrated care model with a home health care physician is a collaboration between regional and municipal health care, working in the patients' home.Methods: Semistructured interviews with patients, next of kin and health care professionals.Results: The home was described by all as the best place to provide health care to these patients, creating safety and increasing autonomy for the patients.The health care professionals found trust in working together as a team, but struggled because of the divided organizations.Patients and next of kin found the Mobile integrated care model to be hierarchic, where the structure sometimes improved participation, and at other times prevented it.Conclusion: All participant groups emphasized that there was a need for more time for the health care personnel to spend with the patients.Furthermore, the patients and next of kin longed for a personal contact and being able to form a relationship with the health care personnel.The health care professionals found being employed by separate organizations as a challenge, where divided documentation systems and lack of equipment hindered the work.Lewy body dementia is a progressive neurodegenerative disease and is considered to be the second most common cause of dementia in the population above 65 years of age.It remains a challenging and complicated disease process to profile clinically with an elusive diagnosis that shares similarities with Alzheimer's, leading to patients being misdiagnosed.The decline is compounded by inappropriate coordinated care efforts, and therefore ill preparing the patient and negatively affecting their relatives and support groups.We describe the case of an 83-year-old Hispanic male who over the course of 32 months sustained multiple injuries due to falls landing him in the emergency department; receiving numerous consultations from hospitalists, surgeons, infectious disease specialists, neurologists, psychiatrists, and